Should Trackable Pill Technologies Be Used to Facilitate Adherence Among Patients Without Insight?

Tahir Rahman

AMA J Ethics. 2019;21(4):E332-336.

doi: 10.1001/amajethics.2019.332.

Abstract

Aripiprazole tablets with sensor offer a new wireless trackable form of aripiprazole that represents a clear departure from existing drug delivery systems, routes, or formulations. This tracking technology raises concerns about the ethical treatment of patients with psychosis when it could introduce unintended treatment challenges. The use of “trackable” pills and other “smart” drugs or nanodrugs assumes renewed importance given that physicians are responsible for determining patients’ decision-making capacity. Psychiatrists are uniquely positioned in society to advocate on behalf of vulnerable patients with mental health disorders. The case presented here focuses on guidance for capacity determination and informed consent for such nanodrugs.

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Ethics and Nanodrug Prescribing

Clinicians often struggle with improving treatment adherence in patients with psychosis who lack insight and decision-making capacity, so trackable nanodrugs, even though not proven to improve compliance, are worth considering. At the same time, guidelines are lacking to help clinicians determine which patients are appropriate for trackable nanodrug prescribing. The introduction of an actual tracking device in a patient who suffers from delusions of an imagined tracking device, like Mr A, raises specific ethical concerns. Clinicians have widely accepted the premise that confronting delusions is countertherapeuti The introduction of trackable pill technology could similarly introduce unintended harms. Paul Appelbaum has argued that “with paranoid patients often worried about being monitored or tracked, giving them a pill that does exactly that is an odd approach to treatment. The fear of invasion of privacy might discourage some patients from being compliant with their medical care and thus foster distrust of all psychiatric services. A good therapeutic relationship (often with family, friends, or a guardian involved) is critical to the patient’s engaging in ongoing psychiatric services.

The use of trackable pill technology to improve compliance deserves further scrutiny, as continued reliance on informal, physician determinations of decision-making capacity remain a standard practice. Most patients are not yet accustomed to the idea of ingesting a trackable pill. Therefore, explanation of the intervention must be incorporated into the informed consent process, assuming the patient has decision-making capacity. Since patients may have concerns about the collected data being stored on a device, clinicians might have to answer questions regarding potential breaches of confidentiality. They will also have to contend with clinical implications of acquiring patient treatment compliance data and justifying decisions based on such information. Below is a practical guide to aid clinicians in appropriate use of this technology.

The information is here.

Super-intelligence and eternal life

Transhumanism’s faithful follow it blindly into a future for the elite

Alexander Thomas
The Conversation
First published July 31, 2017

The rapid development of so-called NBIC technologies – nanotechnology, biotechnology, information technology and cognitive science – are giving rise to possibilities that have long been the domain of science fiction. Disease, ageing and even death are all human realities that these technologies seek to end.

They may enable us to enjoy greater “morphological freedom” – we could take on new forms through prosthetics or genetic engineering. Or advance our cognitive capacities. We could use brain-computer interfaces to link us to advanced artificial intelligence (AI).

Nanobots could roam our bloodstream to monitor our health and enhance our emotional propensities for joy, love or other emotions. Advances in one area often raise new possibilities in others, and this “convergence” may bring about radical changes to our world in the near-future.

“Transhumanism” is the idea that humans should transcend their current natural state and limitations through the use of technology – that we should embrace self-directed human evolution. If the history of technological progress can be seen as humankind’s attempt to tame nature to better serve its needs, transhumanism is the logical continuation: the revision of humankind’s nature to better serve its fantasies.

The article is here.

Consider ethics when designing new technologies

by Gillian Christie and Derek Yach
Tech Crunch
Originally posted December 31, 2016

Here is an excerpt:

A Fourth Industrial Revolution is arising that will pose tough ethical questions with few simple, black-and-white answers. Smaller, more powerful and cheaper sensors; cognitive computing advancements in artificial intelligence, robotics, predictive analytics and machine learning; nano, neuro and biotechnology; the Internet of Things; 3D printing; and much more, are already demanding real answers really fast. And this will only get harder and more complex when we embed these new technologies into our bodies and brains to enhance our physical and cognitive functioning.

Take the choice society will soon have to make about autonomous cars as an example. If a crash cannot be avoided, should a car be programmed to minimize bystander casualties even if it harms the car’s occupants, or should the car protect its occupants under any circumstances?

Research demonstrates the public is conflicted. Consumers would prefer to minimize the number of overall casualties in a car accident, yet are unwilling to purchase a self-driving car if it is not self-protective. Of course, the ideal option is for companies to develop algorithms that bypass this possibility entirely, but this may not always be an option. What is clear, however, is that such ethical quandaries must be reconciled before any consumer hands over their keys to dark-holed algorithms.

The article is here.

Nanoethics as a Discipline?

By Adam Keiper
The New Atlantis: A Journal of Technology and Society
Originally published in 2007, but still relevant today

Here is an excerpt:

The growing interest among academics and activists in the implications of nanotechnology is surely, in some ways, to be welcomed. Serious scholarship and responsible advocacy can serve to enlighten and invigorate policy disputes and thereby play an important role in democratic self-rule. After all, as anyone who follows nanotech policy debates even from a distance can tell you, those debates are awash in spin and misinformation. Environmental groups exaggerate the known dangers of nanoparticles. Firms involved in nanotech investment vie with one another in hyping their projections of how many trillions of dollars the “nanotechnology market,” defined as expansively as possible, will be worth in a few years’ time. Some analysts are ludicrously credulous, while others are just plain confused — like the panelist at a conference in Washington in April 2006 who fretted about Pentagon-funded research on nanosatellites. (Nanosatellites are just small satellites; they have even less to do with nanotechnology than Apple’s “iPod nano” does.) Commentators who are ill-informed or disingenuous or just “shooting from the lip” may, in time, cede the sound bites and the airwaves to the growing ranks of better-informed and more responsible scholars — or at least that’s the theory.

Indeed, that theory seems itself to be the core of nanoethics at the moment. A recurring theme in much of the social-science writing about nanotechnology is the importance of social-science writing about nanotechnology. When you sift through the growing piles of scholarship about media coverage of nanotechnology, about the public understanding of and attitudes toward nanotechnology, about whether there are multiple “publics” who need to be “engaged” in nanotech policy, one sentiment in particular becomes clear — social scientists’ sense of self-importance.

The entire article is here.